Centene has become the latest payer to sue HHS and CMS over its 2027 Medicare Advantage star ratings, filing a complaint Oct. 22 in the U.S. District Court for the Southern District of Georgia.
The action comes under the Administrative Procedure Act. The lawsuit alleged that 17 measures were unlawfully adopted, with all 17 lacking notice-and-comment rulemaking and six relying on improper data sources. Recent lawsuits from Alignment Healthcare and Healthfirst similarly alleged CMS adopted measures without going through the rulemaking process.
Centene estimated that, without the 17 measures in question, its enterprise weighted average would be four stars instead of three, and it would receive about $448 million more in 2028 quality bonus payments and rebate retention. Plans with higher star ratings get payments that can be used to lower member costs and boost benefits. Centene also alleged the lower star ratings have caused “substantial reputational harm.”
“By incorporating unlawful measures into the 2027 star ratings calculation, CMS portrayed Centene’s ratings less favorably in the eyes of Medicare Advantage consumers compared to competing [MA organizations] that benefit from the unlawful measures, thereby undermining Centene’s ability to compete for Medicare beneficiaries,” the lawsuit said.
Centene’s complaint cited Clover Health’s earlier challenge of its 2026 MA star ratings in the same court. The ruling found 20 measures were unlawfully included, and the judge called for a recalculation. The Centene complaint said CMS voluntarily excluded those questioned measures from Clover’s 2027 star ratings, as well. The federal government has appealed the Clover case.
Centene asked the court to declare the measures unlawful, set aside the affected ratings and order CMS to recalculate them without the 17 measures.
CMS told Becker’s it does not comment on pending litigation.
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